Is primary biliary cholangitis still a challenge? Experience of Hassan II University Hospital FES Morocco

Abstract

Introduction: Primary biliary cholangitis is a chronic autoimmune hepatopathy and the leading cause of intrahepatic cholestasis. Treatment is mainly based on ursodesoxycholic acid. The aim of our work is to study the epidemiological, clinical and evolutionary profile of PBC, and to determine the factors predictive of a poor response to UDCA in our context. Materials and methods: This is a retrospective descriptive and analytical study of all cases of PBC followed in our training program from June 2012 to February 2023. Results: We recorded all clinical, diagnostic, therapeutic and evolutionary aspects of 70 cases of PBC. Ninety-two percent ( n= 65) were women. The mean age was 57.3 [24-83] years. The circumstances of discovery were dominated by pruritus, and jaundice. M2-type anti-mitochondrial antibodies were positive in 91.4% of cases. 52.14% of cases had associated autoimmune diseases. Treatment was based on UDCA in all cases, combined with corticosteroids and immunosuppressants for patients with overlap syndrome. A biochemical response after one year of treatment according to Paris II criteria was found in 62.85% (44 cases). In univariate analysis, the factors associated with poor response to treatment were : Discovery of cirrhosis at diagnosis , Decompensated cirrhosis , presence of overlap syndrome , poor compliance with UDCA due to non-availability of medication , initial bilirubin level above 30 mg/l , hypoalbuminemia below 35 g/l. Conclusion: Our study shows the frequency of cirrhosis in PBC, which may explain the low response rate to UDCA, a drug that remains difficult to obtain in our Moroccan context, making prognosis poor and management difficult.